原发性喉小细胞癌六例临床分析

Clinical analysis of 6 cases of primary small cell carcinoma of the larynx

目的探讨原发性喉小细胞癌的临床、病理特点及其诊断、治疗方法并分析其预后。方法回顾性分析中山大学肿瘤防治中心1990年1月至2009年8月诊治的6例原发性喉小细胞癌患者的临床资料，结合临床表现和纤维喉镜活检标本的病理检查确诊原发性喉小细胞癌。本组6例患者中1例放弃治疗，1例行单纯化疗，1例行声门上半喉切除术和辅助放化疗，1例行诱导化疗＋放疗＋辅助化疗，2例行诱导化疗＋同步放化疗＋辅助化疗。化疗药物包括博来霉素、氟尿嘧啶、顺铂、依托泊苷、紫杉醇，化疗3～6周期。放疗采用^60Coγ射线或4MVX射线，常规照射或三维适形放疗，剂量60—66Gy，6—7周。结果6例患者中，除1例临床分期为Ⅲ期外，其余5例均为ⅣA期。随访3～24个月，中位随访时间13个月。1例放弃治疗者3个月后死于呼吸衰竭；2例行同步放化疗者至今分别无瘤生存8个月和24个月，其余3例患者于8～12个月后死于肺或肝转移。结论该病易全身播散，治疗前需行全面评估，化疗在治疗中占有重要地位，同步放化疗是本病的理想治疗模式。

Objective To study the clinical characteristics, pathological features, diagnosis, therapy and prognosis of primary small cell carcinoma of the larynx （ PSCCL ）. Methods Six cases of PSCCL collected from 1990 to 2009 was retrospectively analyzed. The diagnosis was confirmed by pathological examination. Among six patients, one case belonged to stageⅢ, and the others were in stage IVA. One case abandoned treatment; one case received chemotherapy; one case underwent supraglottic hemilaryngectomy and adjuvant chemoradiotherapy ; one case underwent induction chemotherapy, radiotherapy and consolidation chemotherapy. Two cases received induction chemotherapy, concurrent chemoradiation and consolidation chemotherapy. The drug regimens included bleomycin, fluorouracil, cisplatin, etoposide and taxel for 3 - 6 cycles. The radiotherapy technique included conventional radiotherapy, CT-Sim and three dimensional conforma] radiation therapy with ^60 Co or 4 MV X-ray for 60 - 66 Gy during 6 - 7 weeks. Results The time of follow-up was 3 - 24 months and the median was 13 months. Two patients applied with concurrent chemoradiation were alive without tumor. The patient abandoning therapy died of respiratory failure, and the others died of lung or liver metastasis after 8 - 12 months. Conclusions PSCCL is a disseminated disease, so the pretreatment evaluation is nessesary. Concurrent chemoradiation is an ideal treatment model for this disease.